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International Society For Minimally Invasive Cardiothoracic Surgery

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Totally Endoscopic Robotic Ventricular Septal Defect Closure.
Norihiko Ishikawa, Daiki Yoshiyama, Takafumi Horikawa, Ryuta Seguchi, Ryuta Kiuchi, Shigeyuki Tomita, Go Watanabe.
NewHeart Watanabe Institute, Tokyo, Japan.

Objective: We have performed about 800 cases of robot-assisted cardiac surgery. We report our first three cases of totally endoscopic ventricular septal defect (VSD) closure using da Vinci X Surgical System. Methods: From November 2018 to December 2019, three male patients underwent totally endoscopic robotic VSD closure. Echocardiography demonstrated that the perimembranous VSD sizes in three patients were 10, 5 and 6 mm, and Qp/Qs were 2.1, 1.2 and 1.5 respectively. Two patients had tricuspid regurgitation, and another 1 patent had concomitant patent foramen ovale (PFO). VSD closure was directly secured with running sutures in 1 patient and autologous pericardium patched in 2 patients. All the procedures were completed via 5 ports in the right side of the chest. Results: All the VSD repair, tricuspid annuloplasty and PFO closure were completed with the da Vinci surgical system. Mean cardiopulmonary bypass and mean cross-clamp times were 104 and 68 minutes, respectively. No blood transfusions were received. Postoperative echocardiogram demonstrated intact ventricular septum. One patient need pacemaker implantation for postoperative complete atrioventricular block. Conclusions: Total endoscopic robotic VSD closure in adult patients is feasible, but attention should be paid to atrioventricular node as conventional surgery.


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